Palungwachira P, et al. - Despite the promotion of the use of corticosteroids in addition to H1 antihistamines by guidelines for acute urticaria, scarcity of well-designed clinical trials evaluating this approach was identified. Researchers here randomized 75 adult emergency department patients with acute urticaria and a pruritus score > 5 on a visual analog scale into three groups (25 per group): (i) IV chlorpheniramine (CPM) treatment, (ii) IV CPM and IV dexamethasone (CPM/Dex) and (iii) IV CPM and IV dexamethasone with oral prednisolone as discharge medication for 5 days (CPM/Dex/Pred). As per outcomes, adding IV dexamethasone led to no improvement in the treatment of severe pruritus from uncomplicated acute urticaria. They identified a possible link between oral corticosteroid therapy and persistent urticaria activity. Using corticosteroids as an adjunctive treatment is discouraged because of no identified clinical benefits and the potential for side effects.